[Domestic violence as a factor associated to women's health problems]. / La violencia contra la mujer en la pareja como factor asociado a una mala salud física y psíquica.

OBJECTIVE: To study the impact of intimate partner violence (IPV) on women's physical and psychological health. DESIGN: Cross-sectional study. SETTING: Primary care centers in 3 Andalusian provinces. PATIENTS: A total of 425 women, aged 18 to 65 years, were recruited following the same randomisation process in 6 primary care centers. MEASUREMENTS: A self-administered structured questionnaire for this study was used to gather the information. As well as sociodemographic variables, the instrument included questions about IPV, physical health indicators (chronic disease and type, lifetime surgeries, days in bed), psychological health (psychological morbidity, use of tranquilizers, antidepressants, pain killers, alcohol and recreational drugs), self-perceived health and social support. RESULTS: Of 425 women, 31.5% ever experienced any type of partner violence. Women experiencing IPV were more likely to suffer a chronic disease. IPV was significantly associated with a number of adverse health outcomes, including spending more than 7 days in bed in the last three months (ORa=2.96; CI 95%, 1.00-8.76), psychological morbidity (ORa=2.68; CI 95%, 1.60-4.49) and worse self-perceived health (ORa=1.89; CI 95%, 1.04-3.43), after controlling for potential confounding variables. CONCLUSION: This study shows that ever experiencing IPV is associated with a worse psychological and self-perceived health. Physical injuries are not the only "evidence" of the presence of IPV. Primary health care professionals are in a privileged position to help women who are abused by their partners.

Effect of malnutrition during the first year of life on adult plasma insulin and glucose tolerance.

There is evidence linking intrauterine growth retardation with increased cardiovascular risk and diabetes mellitus (DM) later in life. However, little is known about the association between malnutrition during the first year of life and metabolic abnormalities in adulthood. The objective of this study was to assess the effect of documented malnutrition during the first year of life on glucose tolerance, plasma insulin, lipid profile, and blood pressure in early adulthood, as well as to assess the interaction between body mass index (BMI) and malnutrition on these variables. A study group of young men with a documented history of malnutrition during their first year of life was recruited from 4 pediatric hospitals in Mexico City and compared with a control group. Subjects included were 52 men, aged 20.2 +/- 3.6 years, with a mean birth weight of 3.0 +/- 0.7 kg and documented malnutrition in their first year of life; controls were 50 men, aged 23.3 +/- 1.8 years, with a mean birth weight of 3.2 +/- 0.5 kg. Insulin and glucose concentrations, fasting and in response to an oral glucose load, plasma lipids, blood pressure, and an insulin sensitivity index (ISI) were measured. The areas under the curves of glucose (AUCG) and insulin (AUCI) were significantly higher in cases (P =.012 and <.002, respectively), independent of birth weight, BMI, or age. BMI was significantly associated with fasting plasma insulin (FPI), AUCI, ISI, triglyceride, and high-density lipoprotein (HDL)-cholesterol concentrations in cases, but not in controls. These data suggest that early malnutrition in extrauterine life, independently of birth weight, has an adverse effect on insulin metabolism and glucose tolerance in young men, and it worsens as body mass increases even within the normal range of BMI. Therefore, it is advisable to prevent obesity in individuals exposed to early malnutrition.

Insulin resistance and abdominal adiposity in young men with documented malnutrition during the first year of life.

OBJECTIVE: The main objective of the study was to examine the effect of early life malnutrition on the relation between insulin sensitivity and abdominal adiposity in adulthood. It was hypothesised that participants with early life malnutrition would display a more pronounced deterioration of insulin sensitivity in association with a gain in abdominal fat. DESIGN: As a first attempt to investigate this issue, we studied the effect of body fat gains in a cross-sectional context. SUBJECTS: A total of 26 young adult men with evidence of malnutrition during the first year of life and 27 control subjects were recruited for this study. Malnutrition status was determined from medical files of paediatric hospitals in the Mexico City metropolitan area. MEASUREMENTS: Insulin sensitivity was measured by hyperinsulinaemic euglycaemic clamp, and body composition was measured by anthropometrics, bioelectrical impedance and computed tomography. RESULTS: There was a negative correlation between total abdominal adipose tissue area and insulin sensitivity in the previously malnourished and control groups (r(2)=0.65 and 0.35, P<0.01, respectively). When matched for low amounts of abdominal fat (114 cm(2)), participants with and without early life malnutrition had similar insulin sensitivity (9.03 vs 8.88 mg kg(-1) x min(-1)). However, when matched for high amounts of abdominal fat (310 cm(2)) participants who were malnourished during the first year of life had lower insulin sensitivity (4.74 vs 6.85 mg kg(-1) x min(-1), P<0.05). CONCLUSION: Higher levels of abdominal adipose tissue are more detrimental to insulin sensitivity in previously malnourished individuals.

[Reproducibility and sensitivity of a questionnaire on physical activity in a Mexican population]. / Reproducibilidad y sensibilidad de un cuestionario de actividad física en población mexicana.

OBJECTIVE: To assess the reproducibility and sensitivity of a physical activity questionnaire (PAQ) developed at Laval University, to detect differences in lean and obese individuals. MATERIAL AND METHODS: A cross-sectional study was conducted at Mexico's National Institute of Medical Sciences and Nutrition, between January and May 1999. The PAQ was translated into Spanish and adjusted to the Mexican setting. The test-retest method was used to measure reliability, allowing a four-week interval between tests (n = 30 overweight subjects). To assess the questionnaire's sensitivity a group of young cadets (n = 18) was compared to a group of young civilians (n = 32). Concordance was measured through the intraclass correlation coefficient; test-retest was analyzed using the paired or unpaired Student's t test, as necessary. RESULTS: The intraclass correlation coefficient was 0.86. The PAQ was able to show differences of more than 400 kcal/day (1674 kJ/day) and more than 4 kcal/kg/day (17 kJ/kg/day), among young people with high physical activity (t-test). CONCLUSIONS: The PAQ is a sensitive and reliable instrument that can be used in the Mexican population. The English version of this paper is available at: http://www.insp.mx/salud/index.html

[Migration from a rural zone to an urban one is associated with android distribution of body fat in obese women]. / La migración de zona rural a urbana se asocia con la distribución androide de grasa corporal en mujeres obesas.

INTRODUCTION: Studies about migration to industrialized countries have shown an increased prevalence of diabetes, obesity and dyslipidaemias, all of them related to android body fat distribution. Migration status might be influence body fat distribution but it has not been sufficiently investigated. The aim of this study is to determine the relationship between body fat distribution and migration from rural to urban areas in Mexico. MATERIAL AND METHODS: This sequential sample of 433 women were seen in the outpatient obesity clinic of four federal states: Tabasco (n = 81), Mexico City (n = 166), Coahuila (n = 80), and Yucatan (n = 106). Migration history from rural to urban area, familial history of diabetes, ages of onset of obesity, height and weight circumferences were obtained. A regression logistic model was used and maintained as dependent variable body fat distribution. Age and federal state were considered as confounders and they adjusted the model. RESULTS: Migrating women from rural to urban area were 121 (27.9%). The waist circumference was higher in Tabasco (102.2 +/- 12 cm), and lesser in Yucatan (93.6 +/- 15 cm, p < 0.001); no differences were found for hip circumference. The logistic regression model showed that body fat distribution is associated to migration from rural to urban area, and also to diabetes of mother and age of onset of obesity. CONCLUSIONS: Migrating from rural to urban area is a risk factor for android body fat distribution and this risk increases with age, history of diabetes in mother and adulthood onset o obesity.

Open vs. laparoscopic vertical banded gastroplasty: a case control study with a 1-year follow-up.

BACKGROUND: Vertical Banded Gastroplasty (VBG) is one of the most common bariatric operations. It can be performed by open or laparoscopic methods. The purpose of this study was to analyze and compare the 1-year results of 40 patients who underwent laparoscopic (20) and open (20). METHODS: The initial 20 patients undergoing Laparoscopic VBG and the initial 20 patients in whom an Open VBG were performed in our Institution were comparatively evaluated. Demography, surgical details, complications, and 1-year weight loss were analyzed. RESULTS: Both groups were highly comparable in terms of age, sex and body mass index. Laparoscopic VBG was a more prolonged procedure (median 4 hr) than the open VBG (median 3 hr). On the other hand, hospital stay was significantly shorter in the laparoscopic procedure (median 10 days for the open and 6 days for the laparoscopic). One year weight loss and complications were similar in both groups. CONCLUSIONS: Laparoscopic VBG is a safe procedure for the treatment of morbid obesity. This initial series shows comparable results.

Dermatoses in 156 obese adults.

BACKGROUND: Skin diseases are mentioned as a frequent finding in the obese patient. However, to our knowledge no study has been done on this subject. OBJECTIVE: To determine the prevalence of skin diseases associated with different obesity grades and if any dermatosis can be considered an obesity marker. MATERIALS AND METHODS: A cross-sectional study of 156 obese patients who were 110% to 293% overweight were included. Complete medical history and dermatological examination were done. RESULTS: In the 126 female and 30 male obese patients, grades I to V, with a body mass index (BMI) of 27-51, cutaneous findings with statistical significance for linear trend were: plantar hyperkeratosis 54 patients p = 0.00001; acanthosis nigricans 46 patients p = 0.00005; striae 67 patients p = 0.03; skin tags 69 patients p = 0.01; keratosis pilaris 33 patients p = 0.007. Patients with plantar hyperkeratosis were distributed in the obesity groups as follows: grade I = 3 patients; grade II = 7 patients; grade III = 8 patients; grade IV = 17 patients; and grade V = 19 patients. Of the 76 diabetic patients, 26 had acanthosis nigricans, 38 had skin tags, and 27 had plantar hyperkeratosis. DISCUSSION: Plantar hyperkeratosis should be considered as a cutaneous stigma of severe obesity. This is probably a result of pressure directly related to the excess weight.

Diseases and problems secondary to massive obesity.

Morbid obesity is a health hazard. It carries several health risks and decreases life expectancy. Individuals with morbid obesity may develop one or more complications. These are mainly cardiovascular, metabolic, respiratory, gastrointestinal, renal, genitourinary and gynaecological. Patients with morbid obesity also have a high surgical risk. This review analyses the most common complications of morbidly obese patients and their changes after surgically induced weight loss.

The apolipoprotein E4 allele is not associated with an abnormal lipid profile in a Native American population following its traditional lifestyle.

The apolipoprotein E4 allele is associated in industrialized countries with an elevated LDL cholesterol concentration and an increased cardiovascular risk. Our purpose in this study was to assess the influence of the genetic variation at the APOE gene locus on the lipid profile of a Native American rural population. We examined plasma lipid levels and the common apo E alleles in 142 healthy randomly selected adults living in their native communities in western Mexico. Their age was 38+/-17 years and the BMI 25.7+/-4.5 kg/m2. Plasma cholesterol, triglycerides, LDL C and HDL C were 165+/-29.6, 126+/-83, 98+/-26 and 42+/-12.7 mg/dl respectively. Ninety-one per cent of the subjects had Lp(a) concentrations below 20 mg/dl and 30% had levels lower than 2 mg/dl. The most common APOE genotype was E3/3 (63%), followed by E3/4 (30.1%). The prevalence of the E2 allele was very low (2.3%). No difference was observed in LDL C concentrations between the E3/E3 and E3/E4 subjects; however carriers of the E2/3 genotype had lower LDL C levels. Similar results were obtained for cholesterol and apo B levels. In summary, the increased LDL C levels associated with the E4 allele in previous studies were not observed in a population with non-westernized habits. Environmental factors, such as diet and lifestyle, could outweigh the hypercholesterolemic predisposition resulting from the presence of the apo E4 allele.

Normas para el control de la glucosa: conceptos actuales / Glucose control: current concepts

El Estudio sobre Control y Complicaciones de la Diabetes (DCCT por su sigla en inglés) llevó a su fin décadas de controversia sobre la necesidad de control estricto de la glucemia en la diabetes de tipo 1, porque demostró que el control de la glucosa mediante el uso de terapia intensa con insulina reduce significativamente las complicaciones microvasculares a largo plazo. Las normas de la Asociación Americana de Diabetes (ADA) apoyan empíricamente la misma meta de tratar siempre de obtener normoglucemia en pacientes con el tipo 2 de esta enfermedad; sin embargo, en tal caso y al contrario de lo que ocurre en el tipo 1, la insulina es solo tercera opción después de la dieta, el ejercicio y los medicamentos hipoglucemiantes orales. Datos recientes sobre tratamiento en diabetes del tipo 2 sugieren que la insulina plantea riesgos cardiovasculares aumentados en esa población que ya de suyo tiene tales riesgos. Sin embargo, muchos diabéticos de tipo 2 eventualmente requieren insulina. Es claro que se necesitan mas estudios para valorar los riesgos, beneficios y posibilidad de mejor control de la glucosa en la diabetes de tipo 2. Pero dos principios están claros: primero, que promover niveles de glucemia cercanos a la normalidad es factor importante para prevenir las complicaciones microvasculares a largo plazo; y segundo, que la diabetes de tipo 2 incluye una variedad de condiciones metabólicas y por consiguiente se requieren esfuerzos integrados de los enfermos y de los profesionales que prestan servicios de salud, para llevar a cifras óptimas la glucosa sanguínea y los lípidos séricos y así minimizar los factores de riesgo cardiovascular

Anesthesia for morbidly obese patients.

Bariatric surgery is the most effective method for treating patients with morbid obesity, and participation of the anesthesiologist in the treatment of these patients is more and more frequent. Therefore it is important for anesthesiologists to be familiar with anatomic and physiologic implications and the pharmacologic changes associated with obesity, so they can offer optimal perioperative treatment. The present study describes a series of 37 patients with an average body mass index of 50.3 kg/m2 who underwent bariatric surgery in a third-level teaching hospital in Mexico City. Preoperative assessment, airway management, perioperative treatment, and the incidence of complications are analyzed. We found a high frequency of associated diseases, among which diabetes mellitus and systemic arterial hypertension were the most prominent. Cardiorespiratory complications such as obstructive sleep apnea syndrome and obesity-hypoventilation syndrome were particularly frequent (16.2% and 22.0%, respectively). Both general anesthesia and mixed anesthesia (peridural block plus light general anesthesia) were employed. The incidence of complications related to perioperative and anesthetic management was low. We discuss and propose protocols for the evaluation and management of airway and associated cardiorespiratory complications.

Cardiac abnormalities associated with morbid obesity.

Morbidly obese patients are at increased risk for structural and functional abnormalities of the heart. This paper summarizes the effects of obesity on the heart, the effect of weight reduction on cardiac function, the impact of coronary artery disease on cardiac cardiomyopathy, and our experience in obesity heart disease at the Instituto Nacional de la Nutrición in Mexico.

[The clinical usefulness and efficacy of adenosine triphosphate in an emergency service]. / Utilidad y eficacia clínica del adenosín trifosfato en un servicio de Urgencias.

We studied 89 patients diagnosed in our emergency department of paroxysmal supraventricular tachycardia, to describe the efficacy and safety of intravenous adenosine triphosphate (ATP) in their treatment. All received a first bolus of 10 mg of ATP and if no electrical response was observed, a second dose of 20 mg. This treatment was successful in 91% of the patients, lasting of 26.9 seconds to resolve the episode, and in the 53% of the patients with the first dose. In 9% of the patients ATP did not resolve the episode but allowed to diagnose it, which in five patients was atrial flutter, in 2 Wolff-Parkinson-White syndrome and in one atrial fibrillation. Adverse effects appeared in 25.6% of the cases, being in all transitory and banal. ATP is a very effective and safe drug for the treatment of patients with PSVT.

[Treatment of extreme obesity]. / Tratamiento quirúrgico de la obesidad extrema.

23 patients whose weight varied from ninety-eight to 220 kilos were subjected to four different types of jejuno-ileal by pass operations: terminal-lateral (14 X 4) in three, terminal-terminal (14 X 4) in fifteen, (12 X 8) in two, and (10 X 8) in three. The defunctionalized intestine was anastomized to the transverse colon. Liver, jejenum and ileal biopsies as well as profilactic apendectomy were performed in all the cases along with colecistectomy when possible. All our patients were carefully studied in the pre and postoperative periods. The postoperative follow-up varied from 16 to 72 months, during which time a short and long-term mortality of 8.6% was observed. In eight patients it was necessary to reestablish normal intestinal transit for one or two reasons: rapid weight loss or total lack of patient cooperation. During the first few months post-op, diarrhea, nausea, vomiting, loss of apetite, weakness, inactivity, depression, electrolyte anormalities, anemia and increased hepatic esteatosis were the clinical and pathological findings most frequently encountered. With the cooperation of the patient it is possible to correct all these alterations: it is for this reason that the importance of right patient selection is emphasized. The rate of post-operative weight loss varied from patient to patient with an ideal weight being achieved between 18 and 24 months after the operation. Only in those patients reoperated upon to establish normal intestinal transit was the lost weight recuperated. Along with rigid patient selection, the success of this operation depends upon interspecialty teamwork during the preoperative evaluation as well as the follow up period in order to resolve the intricate physio-pathological problems that so frequently arise.